QRS 24 Page 2 of 4 Issue Q dated 07/07/17

EN4179 EXAMINATION APPLICATION FORM

Please complete this form and email to: (0044) 01279 870 276

PART A – Candidate Details

Candidate Full Name
(as you wish to be shown on your certificates)
Candidate Telephone Number
Candidate Email
Company Name
Or Self Sponsored
Company Address

PART B – Examination Details

NDT Method / PT
☐ / MT
☐ / ET
☐ / UT
☐ / RT
☐ / FI
☐ / BRS ☐ / IRT ☐ / BASIC ☐ / HT
☐ / CT
☐ / AFD ☐ / ETCH
☐
Other ☐ Specify: Click or tap here to enter text.
Type of Inspection Normally Performed / ☐ Aircraft Inspection / ☐ Engine Over-Haul / ☐ Wheel & Brakes / ☐ Manufacturing / Other: Click or tap here to enter text.
Level / 1 Ltd ☐ / 1 ☐ / 2 ☐ / 3 Only ☐ / 3 Inc. L2 Practical ☐
Type / Initial ☐ / Recertification ☐ / Re-sit ☐
Please complete line below / Supplementary ☐
Please complete line below
Complete for Supplementary or Re-sit ONLY / General
Theory ☐ / Specific
Theory ☐ / Full
Practical ☐ / Part
Practical ☐ / Instruction ☐
Date of Examination
Location: / AIT Takeley
☐ / Other ☐ Specify:.
Qualification Specification / EN4179 ☐ / NAS 410 ☐ / SNT- TC-1A ☐
Additional Information

Part C – Written Practice & Company Responsible Level 3

AN ELECTRONIC COPY OF YOUR COMPANY WRITTEN PRACTICE / PROCEDURE FOR CERTIFICATION OF NDT PERSONNEL MUST BE SENT TO AIT PRIOR TO CONFIRMATION OF EXAMINATION

WP Revision / Issue No / Our company does not have a Written Practice and we need to discuss its preparation with AIT: / YES / NO
Written Practice Title / Reference
Name of Your Company
Responsible Level 3
Responsible Level 3
Email Address / Responsible Level 3
Phone Number

Note: Part D & E do not need to be completed if this form is to be submitted with a completed QRS20

Part D – Dietary Requests

Special Dietary Requirements:

Part E – Invoice & Payment

Does your Purchase Order Number need to be quoted on the invoice? / YES ☐ / If Yes:
Purchase Order Number:
please provide a copy to support your application:
NO ☐
How will the invoice be paid: / Credit/Debit Card ☐
(We do not accept American Express) / Cash ☐
(Ensure that you have the exact amount as we do not hold change) / Cheque ☐
(UK Only) / BACS ☐
(Bank Transfer)
Company VAT Number:
Invoice address if different from the company address:
Accounts department email contact:
How would you like your training/examinations documents delivered to you? Please select as desired: / ☐ Free UK Postal Service
No Tracking or Signature.
AIT cannot be held responsible for any loss or damage of documentation. / ☐ AIT Courier Charged to You at Cost
Tracking Available – signature is required upon receipt, PO Box addresses must not be used. / ☐ I will Arrange Collection of all Documents

Part F – Specific Theory Examination - EN4179 3.30, 4.1.2 & 7.13

List the specifications used by your employer which shall be required in the specific theory examination.
Revision number or issue status to be included.
Aerospace Inspection Training will require electronic copies of all specifications listed.
Specification/Manual: / Revision/Issue:
Specification/Manual: / Revision/Issue:
Specification/Manual: / Revision/Issue:
Specification/Manual: / Revision/Issue:
Specification/Manual: / Revision/Issue:
Specification/Manual: / Revision/Issue:
Specification/Manual: / Revision/Issue:
Do you require questions on Product Technology to be included? / .

ALL OF PARTS G, H & J MUST BE COMPLETED

Part G – Practical Examination – EN4179 3.32, 4.1.2 & 7.14

PENETRANT INSPECTION
Techniques Used / ☐ Type 1 Method A / Water Washable / ☐ Type 1 Method C / Solvent Removable / ☐ Type 1 Method D / Post Emulsifiable
Types of Material / ☐ Titanium / ☐ Casting / ☐ Aluminium
MAGNETIC PARTICLE INSPECTION
Select Type of Work / ☐ Stationary Bench / ☐ Portable Equipment
Techniques Used / ☐ Current Flow / ☐ Threader Bar / ☐ Coil / ☐ Yoke
EDDY CURRENT INSPECTION
Techniques Used / ☐ High Frequency / ☐ Low Frequency / ☐ Rotary
Type of Testing / ☐ Manual Handheld Scanning / ☐ Automated Wheel Scan
ULTRASONIC INSPECTION
Techniques Used / ☐ Compressional Wave / ☐ Shear Wave
Types of Material / ☐ Metallic / ☐ Composite
Type of Testing / ☐ Manual Handheld Scanning / ☐ Automated Immersion / ☐ Manual Immersion / ☐ Automated Dry
RADIOGRAPHY INSPECTION
Select Type of Work / ☐ Aircraft
Inspection / ☐ Welds / ☐ Castings in Manufacturing / ☐ Composites in Manufacturing
Techniques Used / ☐ X-Ray Film / ☐ X-Ray Non-Film
THERMOGRAPHY INSPECTION
Type of Testing / ☐ Heat Gun / ☐ Heat Blanket / ☐ Fridge / Freezer
HARDNESS TESTING / CONDUCTIVITY TESTING / ETCH INSPECTION & ANODIC FLAW DETECTION
Provide Details Here:

Part H – Instruction Writing EN4179 3.34

Is Instruction Writing Required? / Yes ☐ / No ☐

Part I – Additional Information

Additional Exam Information If Required

Part J – Company Responsible Level 3 Authorisation

Responsible Level 3 Signature: / / Date of Signature: / Click or tap to enter a date.
AIT Will Only Accept This Application Form Once It Has Been Signed by Your Company Responsible Level 3
FOR INTERNAL USE ONLY
Acknowledgment of the above examination is now confirmed
AIT Examination
Co-ordinator Signed:
Date:
Comments / Limitations: